title: Psychological and physiological responses following repeated peer death.
abstract: OBJECTIVE
  Undergraduates at a university in the United States were exposed - directly and indirectly - to 14 peer deaths during one academic year. We examined how individual and social factors were associated with psychological (e.g., anxiety, depression, somatization) and physiological (i.e., cortisol) distress responses following this unexpected and repeated experience with loss.
  
  
  METHODS
  Two to three months after the final peer death, respondents (N = 122, 61% female, 18-23 years, M = 20.13, SD = 1.14) reported prior adverse experiences, degree of closeness with the deceased, acute responses to the peer deaths, ongoing distress responses, social support, support seeking, and media viewing. A subset (n = 24) returned hair samples for evaluation of cortisol responses during the previous 3 months.
  
  
  RESULTS
  Ongoing psychological distress was associated with a) prior interpersonal trauma, b) fewer social supports, and c) media exposure to news of the deaths (p's<.05). Participants who had no prior bereavements showed, on average, high cortisol (>25 p/mg) compared to individuals with one or two prior bereavement experiences (who were, on average, within the normal range, 10 to 25 p/mg) (p<.05). Only 8% of the sample utilized available university psychological or physical health resources and support groups.
  
  
  CONCLUSIONS
  Limited research has examined the psychological and physiological impact of exposure to chronic, repeated peer loss, despite the fact that there are groups of individuals (e.g., police, military soldiers) that routinely face such exposures. Prior adversity appears to play a role in shaping psychological and physiological responses to repeated loss. This topic warrants further research given the health implications of repeated loss for individuals in high-risk occupations and university settings.
authors.affiliation: Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada.
authors.forename: Judith Pizarro
authors.initials: JP
authors.lastname: Andersen
authors.forename: Roxane Cohen
authors.initials: RC
authors.lastname: Silver
authors.forename: Brandon
authors.initials: B
authors.lastname: Stewart
authors.forename: Billie
authors.initials: B
authors.lastname: Koperwas
authors.forename: Clemens
authors.initials: C
authors.lastname: Kirschbaum
mesh_terms: D001293:Attitude to Death; D005260:Female; D006197:Hair / Q000737:chemistry; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D008016:Life Change Events; D008297:Male; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D013334:Students; D055815:Young Adult
chemical_list: D006854:Hydrocortisone